Combined use of rituximab and plasmapheresis pre‐transplant increases post‐transplant infections in renal transplant recipients with basiliximab induction therapy

Chung, Byung-Ha; Yun, Jintak; Ha, Sung Eun; Kim, J.I.; Moon, In-Sung; Choi, Bum Soon; Park, C.W.; Kim, Y.S.; Yang, Chul-Woo

doi:10.1111/tid.12135

Cited by 32 publications

(35 citation statements)

References 28 publications

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“…This finding was consistent with previous reports that strong pre-transplant desensitization increases infection-related mortality during the early post-transplantation period in ABOi-KT. [16–19] Recently, however, there is a trend to decrease desensitization intensity and maintenance immunosuppression dose; [8, 20–22 hence, we expect that the infection-related mortality might be decreased in the future.…”

Section: Discussionmentioning

confidence: 99%

Impact of ABO incompatible kidney transplantation on living donor transplantation

Chung

Yang

2017

PLoS ONE

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BackgroundABO incompatible kidney transplantation (ABOi-KT) is an important approach for overcoming donor shortages. We evaluated the effect of ABOi-KT on living donor KT.MethodsTwo nationwide transplantation databases were used. We evaluated the impact of ABOi-KT on overall living donor transplant activity and spousal donation as subgroup analysis. In addition, we compared the clinical outcome between ABOi-KT and ABO compatible KT (ABOc-KT) from spousal donor, and performed a Cox proportional hazards regression analysis to define the risk factors affecting the allograft outcomes.ResultThe introduction of ABOi-KT increased overall living donor KT by 12.2% and its portion was increased from 0.3% to 21.7% during study period. The ABOi-KT in living unrelated KT was two times higher than that of living related donor KT (17.8 vs.9.8%). Spousal donor was a major portion of living unrelated KT (77.6%) and ABOi-KT increased spousal donation from 10% to 31.5% in living donor KT. In addition, increasing rate ABOi-KT from spousal donor was 10 times higher than that of living related donor. The clinical outcome (incidence of acute rejection, allograft function, and allograft and patient survival rates) of ABOi-KT from spousal donor was comparable to that of ABOc-KT. Neither ABO incompatibility nor spousal donor was associated with acute rejection or allograft failure on multivariate analysis.ConclusionsABOi-KT increased overall living donor KT, and ABOi-KT from spousal donor is rapidly increasing with favorable clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Impact of ABO incompatible kidney transplantation on living donor transplantation

Chung

Yang

2017

PLoS ONE

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“…Imaging studies, particularly highresolution CT, are another important bedside tool for determining the cause of acute respiratory failure. 69 This Review does not detail the radiological findings in immunocompromised patients with acute respiratory failure. Patterns of lung involvement are an important piece of the puzzle but are not predictive of a specific cause.…”

Section: Haematological Malignanciesmentioning

confidence: 99%

“…Patterns of lung involvement are an important piece of the puzzle but are not predictive of a specific cause. 69 However, a combination of positive and negative high-resolution CT findings suggest specific causes of lung infiltrates. 70 Different components of the DIRECT mnemonic contribute to determining the pre-test clinical probability for each individual diagnosis (figure 3).…”

Section: Haematological Malignanciesmentioning

confidence: 99%

Acute respiratory failure in immunocompromised adults

Azoulay

Mokart

Kouatchet

et al. 2019

The Lancet Respiratory Medicine

115

100

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Acute respiratory failure occurs in up to half of patients with haematological malignancies and 15% of those with solid tumours or solid organ transplantation. Mortality remains high. Factors associated with mortality include a need for invasive mechanical ventilation, organ dysfunction, older age, frailty or poor performance status, delayed intensive care unit admission, and acute respiratory failure due to an invasive fungal infection or unknown cause. In addition to appropriate antibacterial therapy, initial clinical management aims to restore oxygenation and predict the most probable cause based on variables related to the underlying disease, acute respiratory failure characteristics, and radiographic findings. The cause of acute respiratory failure must then be confirmed using the most efficient, least invasive, and safest diagnostic tests. In patients with acute respiratory failure of undeter mined cause, a standardised diagnostic investi gation should be done immediately at admission before deciding whether to perform more invasive diagnostic procedures or to start empirical treatments. Collaborative and multidisciplinary clinical and research networks are crucial to improve our understanding of disease pathogenesis and causation and to develop less invasive diagnostic strategies and more targeted treatment options.www.thelancet.com/respiratory Vol

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“…In addition, there are serious risks associated with IVIG use, including renal failure in sucrose-high IVIG products, thrombotic episodes and hemolysis [24]. When plasmapheresis is used alone, the risk for infection even in immunocompromised patients does not tend to increase [25]; however, when plasmapheresis and RTX are used together before KT, posttransplant infections reportedly increase [26]. This reiterates the principle that ISs should be used with caution and only in certain conditions.…”

Section: Discussionmentioning

confidence: 99%

Effect of Pretransplant Rituximab Use on Posttransplant Clinical Outcomes in Patients with High Panel Reactive Antibody Scores

Hwang

Chung²,

Oh³

et al. 2015

Nephron

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Background/Aims: Whether desensitization treatment is needed before kidney transplant (KT) in patients with high panel reactive antibody (PRA) scores but negative cross-matching (XM) tests remains controversial. This study aimed to investigate the effect of pretransplant rituximab (RTX) treatment on clinical outcomes in these patients. Methods: The study included 52 patients with PRA >50% but negative XM tests before transplantation. A single dose of RTX was administered before KT in 32 patients (RTX group). The 20 patients without RTX treatment were considered as controls (CON group). We compared the development of acute antibody-mediated rejection (AMR), rejection-free survival, allograft function, allograft and patients' survival rates and infection rates between the 2 groups. Results: The rate of acute AMR development was significantly lower in the RTX group than in the CON group (p = 0.009), and rejection-free survival in the RTX group was higher than in the CON group (p = 0.042). The 3-year graft and patient survival rates were higher in the RTX group than in the CON group (p = 0.007 and p = 0.037, respectively). There were no significant differences in infection rates between the groups. Conclusions: Pretransplant use of RTX improved the post-transplant clinical outcomes in patients with high PRAs but negative XM tests.

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Combined use of rituximab and plasmapheresis pre‐transplant increases post‐transplant infections in renal transplant recipients with basiliximab induction therapy

Abstract: Our results show that in the setting of basiliximab induction, the use of combined RTX and PP therapy pre-transplant significantly increases the risk for post-transplant infection.

Cited by 32 publications

References 28 publications

Impact of ABO incompatible kidney transplantation on living donor transplantation

Impact of ABO incompatible kidney transplantation on living donor transplantation

Acute respiratory failure in immunocompromised adults

Effect of Pretransplant Rituximab Use on Posttransplant Clinical Outcomes in Patients with High Panel Reactive Antibody Scores

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